CSPINE Injury Prediction Rule Could Decrease Radiographic Imaging Exposure in Children

• September 23, 2024
• Katelyn Scott

A new study shows that implementing the rule can reduce CT scans by more than 50% without missing clinically significant injuries.

While cervical spine injuries (CSI) are uncommon in children, they can be potentially devastating, resulting in quadriplegia — paralysis below the neck affecting both arms and both legs. Detecting CSIs in a clinical setting often requires imaging such as X-rays and computed tomography (CT) scans, both of which expose children to radiation, which can cause other health issues over time.

In a study published in The Lancet Child & Adolescent Health, researchers in the Pediatric Emergency Care Applied Research Network (PECARN) — led by Julie Leonard, MD, MPH, at Nationwide Children’s Hospital — created a highly accurate cervical spine injury prediction rule. When applied, the rule decreases the use of CT by more than 50% without missing clinically significant injuries or increasing normal X-ray use.

“Emergency medical professionals prioritize thoroughness to ensure no serious injuries are overlooked, a crucial aspect in caring for every trauma patient,” says Dr. Leonard, an emergency medicine physician at Nationwide Children’s. “However, we also understand the age-related radiation sensitivity and malignancy risk caused by use of CT, and we’re very encouraged that this new prediction rule could reduce some of that unnecessary exposure.”

More than 22,000 study participants were enrolled at 18 children’s hospitals over three years. The resulting PECARN CSI prediction rule is easy for physicians to use, relying solely on a child’s symptoms and physical examination upon arrival in the emergency department. The prediction consists of nine clinical findings, four of which designate a child as “high-risk” for CSI and appropriate for initial screening with CT.

The risk factors, identified solely through the child’s physical complaints and examination, are Glasgow Coma Score (GCS) score of 3–8; unresponsive on the Alert, Verbal, Pain, Unresponsive scale (AVPU); abnormal airway, breathing, or circulation; focal neurological deficit including paresthesia, numbness, or weakness; altered mental status (GCS score of 9–14, verbal or pain on the AVPU, or other signs of altered mental status); neck pain; posterior midline neck tenderness; substantial torso injury; and substantial head injury.

“More research needs to be completed to determine how best to implement this rule into community emergency department settings, where most children are evaluated after trauma,” says Dr. Leonard, who is the principal investigator of the Great Lakes Atlantic Children’s Emergency Research node (GLACiER) of the PECARN. “We look forward to continuing the implementation work to improve care for children affected by traumatic injuries.”

This article also appears in the Fall/Winter 2024 print issue. Download the full issue.

Reference:

Leonard JC, Harding M, Cook LJ, Leonard JR, Adelgais KM, Ahmad FA, Browne LR, Burger RK, Chaudhari PP, Corwin DJ, Glomb NW, Lee LK, Owusu-Ansah S, Riney LC, Rogers AJ, Rubalcava DM, Sapien RE, Szadkowski MA, Tzimenatos L, Ward CE, Yen K, Kuppermann N. PECARN prediction rule for cervical spine imaging of children presenting to the emergency department with blunt trauma: a multicentre prospective observational study. Lancet Child & Adolescent Health. 2024;8(7):482-490.

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